Commentary: Mental health should be part of annual visit to the doctor

The suicide of actor-comedian Robin Williams shocked multiple generations and quickly sent TV tongues wagging about the actor’s admitted battles with addiction and depression. The pundits bemoaned the stigma surrounding mental illness and substance use disorder while adding yet another Hollywood star’s name to the roll call of those experiencing an untimely death.

The suicide roll call claims an astounding 30,000 people a year, according to SAVE (Suicide Awareness Voices of Education). For every person who completes a suicide, there are 20 more who tried to end their lives and did not complete the suicidal act. The strongest risk factor for suicide is depression. The World Health Organization finds depression to be the leading cause of disability worldwide in terms of years lost to disability. Yes, years.

Williams was not alone in experiencing the double whammy of depression and addiction. Data reviews by the National Institute on Drug Abuse have found that people diagnosed with mood or anxiety disorders are twice as likely to suffer also from a drug use disorder. Similarly, people diagnosed with drug use disorders are roughly twice as likely to experience mood or anxiety disorders.

It’s time to add the mental health check up to the annual doctor visit.

Primary care doctors and their clinic support teams are measured on their effectiveness in treating diabetes, high blood pressure, obesity and tobacco use. Depression and substance use disorder also belong on the list and the doctors deserve the tools and resources necessary to make a difference.

The Brown County Alcohol Task Force has set a noble goal of 70 percent of primary care doctors and their clinic teams to include depression and substance use disorder screenings in office visits. Clinics moving in this direction are adding health educators to screen the patients and motivate those in need of additional help to connect with a mental health or substance use disorder counselor for follow up care.

Medicaid and 13 other commercial health plans in Wisconsin have reimbursed clinics when the health educators deliver services under supervision of credentialed providers. Medicaid reimburses $35 for each brief (10-minute) assessment and $20 for each 15-minute intervention. Delivering just six assessments and two interventions per day can pay for the health educator’s compensation, leaving them with several additional hours to generate more revenue or provide uncompensated care.

WIPHL’s pilot programs report high patient satisfaction with the service. About 30 percent of the patients screen positive for binge drinking and 5 percent for illicit drug use.

Fifty years ago, President John F. Kennedy said, “Central to a new mental health program is comprehensive community care. We need a new type of health facility, one which will return mental health care to the mainstream of American medicine and at the same time upgrade mental health services.